SUMMARY: This final rule implements provisions of the Patient Protection and Affordable
Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively referred to
as the Affordable Care Act. This final rule finalizes new Medicaid eligibility provisions;
finalizes changes related to electronic Medicaid and the Children’s Health Insurance Program
(CHIP) eligibility notices and delegation of appeals; modernizes and streamlines existing
Medicaid eligibility rules; revises CHIP rules relating to the substitution of coverage to improve
the coordination of CHIP coverage with other coverage; and amends requirements for
benchmark and benchmark-equivalent benefit packages consistent with sections 1937 of the
Social Security Act (which we refer to as “alternative benefit plans”) to ensure that these benefit
packages include essential health benefits and meet certain other minimum standards. This rule
also implements specific provisions including those related to authorized representatives,
notices, and verification of eligibility for qualifying coverage in an eligible employer-sponsored
plan for Affordable Insurance Exchanges. This rule also updates and simplifies the complex
Medicaid premium and cost sharing requirements, to promote the most effective use of services,
and to assist states in identifying cost sharing flexibilities. It includes transition policies for 2014
I’ve just quickly glanced through this summary of the regulations and — counting the bolded phrases – I think there are 8 instances of some level of change to the regulations and rules regarding various aspects of the PPACA. Some of those bolded phrases are actually multiple decisions so that number isn’t exact.
I am shocked speechless by the audacity of this document. I cannot imagine how a program whose goals are shifting so quickly and dramatically can ever be implemented.
Thankfully, Lambert pulled it all together. Please follow the link and read the whole thing:
This really is an epic #FAIL, technically, politically, and morally. Let’s take a look at how ObamaCare was supposed to work:
Simplifying drastically — really! — ObamaCare is designed to toss citizens consumers into buckets depending on their (projected) income (MAGI) and whether they get insurance from their employer. There’s a big bucket labeled “Medicaid” that ObamaCare forces citizens consumers into if they’re too poor, and there are several other buckets labeled “Exchange” (sometimes “Marketplace”) that have different subsidies attached, depending again on income, and what percentage of their income employer insurance (if any) represents. The ObamaCare Exchanges (“marketplaces”) were supposed to be implemented online, and even though comparisons to Expedia or Travelocity were beyond absurd, there was and may even still be some remaining hope that we’ll end up with something like TurboTax. And the exchanges were going to do all this figuring in real time: Log on, fill out a form, get tossed in a bucket, sign up.
So first, let’s talk about the technical #FAIL: You can see right away from that description that the Exchange system (I’m going to stop calling them marketplaces even though that’s what the HHS PR people want) presents a massive systems integration problem. You as a citizen consumer must (1) prove your identity (integrate credit reporting agencies), (2) your citizenship (integrate DHS), (3) your income (integrate IRS), (4) state Medicaid eligibility requirements (integrate each state), and (5) the insurance, if any, your employer offers you (integrate employer reporting); ObamaCare needs all that to throw you into the right bucket. Even leaving aside the fact that all this data is going to be dirty, as we know from the NSA scandals, it’s all kept in databases whose schemas differ and must be mapped to each other, and which need to be connected together with complicated and expensive Intertubal plumbing. Not easy.
And with less than 3 months to implement all this — I would say, impossible.